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首页> 外文期刊>Open Journal of Urology >A Patient with Spinal Arteriovenous Malformation Treated with Lumbar Vertebral Surgery Due to Misdiagnosis
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A Patient with Spinal Arteriovenous Malformation Treated with Lumbar Vertebral Surgery Due to Misdiagnosis

机译：由于误诊，患有腰椎手术治疗脊柱动脉畸形的患者

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Spinal arteriovenous malformation (AVM) is a rare disease that arises more commonly from the lower thoracic and upper lumbar spine. It is classified based on the development pattern and the shunt location. The developmental mechanism of the symptoms is thought to be as follows. Spinal venous return is impaired by high-pressure arterial blood flowing into the coronary sinus via a shunt and venous pressure is promoted, which causes spinal cord symptoms to progress gradually. Listlessness, pain, and an abnormal sensation of the lower limb are possible initial symptoms. Spinal AVM may cause intermittent claudication and bladder and rectal disturbance, and differentiation from lumbar degenerative diseases and arteriosclerosis obliterans is required, which may cause difficulty with diagnosis. We encountered a patient in whom intermittent claudication was treated with lumbar decompression and fixation at another hospital, but symptoms did not improve. The patient was diagnosed with spinal AVM at our hospital and symptoms were improved by surgery. Because the symptoms did not improve despite being treated with surgery for spinal canal stenosis, we strongly suspected spinal intermittent claudication, and we performed a spinal CT and MRI after myelography for the entire spinal cord, and identified the lesion in the thoracic spinal cord. Regarding the postoperative outcome and prognosis of spinal dural AVF, early diagnosis and early treatment have been proposed as prognostic factors because the postoperative outcome is poor in patients with high preoperative severity and a long duration of illness. In our patient, the preoperative JOA score was 6, showing high preoperative severity, and the duration of illness was 1.5 years before diagnosis, which may explain the limited improvement of the JOA score to 20 at final follow-up. In a case with these characteristics, we suggest that close examination of the entire spinal cord is needed for effective treatment.
机译：脊柱动静脉畸形（AVM）是一种罕见的疾病，从而从下胸椎和上腰椎产生更常见的疾病。它基于开发模式和分流位置进行分类。症状的发育机制被认为如下。通过促进分流和静脉压力流入冠状动脉窦的高压动脉血液损害脊柱静脉返回，促进脊髓症状逐渐进展。无精打采，疼痛和下肢的异常感觉是可能的初始症状。脊髓AVM可能导致间歇性跛行和膀胱和直肠扰动，并且需要与腰椎退行性疾病的分化，并且是可能导致诊断困难的困难。我们遇到了一个患者，其中患有腰椎减压和在另一医院的腰椎减压和固定，但症状并没有改善。患者被诊断患有脊髓AV​​M，在我们的医院，手术症状得到改善。由于症状并未改善尽管用脊柱管狭窄的手术治疗，因此我们强烈怀疑脊柱间歇性跛行，并且我们在整个脊髓的髓鞘中进行了脊髓CT和MRI，并确定了胸腔脊髓的病变。关于脊柱Dural AVF的术后结果和预后，已经提前诊断和早期治疗被提出为预后因素，因为术后术后术后的患者较高，患者较高，疾病较长。在我们的患者中，术前Joa得分为6，呈现出高术前严重程度，诊断前的疾病持续时间为1.5年，这可能在最终随访时解释JOA得分对20的有限改善。在具有这些特性的情况下，我们建议需要对整个脊髓进行密切检查进行有效治疗。

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